Comparison of cytological adequacy in ultrasound-guided fine-needle aspiration of thyroid nodules with different numbers of needle passes.

OBJECTIVE: The aim of this study was to compare the cytological adequacy rates of different needle passes in ultrasound-guided fine-needle aspiration biopsy of thyroid nodules and, thus, to help establish the criterion for selecting the number of needle passes according to the characteristics of thyroid nodules. PATIENTS AND METHODS: This single-center and randomized prospective study involved 207 consecutive patients with 240 solid or predominantly solid thyroid nodules. These nodules were randomly divided into a 1-pass group, a 2-pass group, and a 3-pass group. Then the nodules were sent for cytopathological diagnosis, and cytological results were classified according to the Bethesda classification. Bethesda I was defined as inadequate, and Bethesda Ⅱ-Ⅵ were defined as adequate. Then the cytological adequacy rates of different groups were compared. RESULTS: In total, 221 nodule specimens were considered as adequate and 19 nodule specimens inadequate. The overall adequacy rate was 92.1%. However, there were no significant differences among the 1, 2, and 3-pass groups in terms of adequacy rates (91.3%, 92.5%, and 92.5%, respectively). CONCLUSIONS: The number of needle passes does not significantly affect the cytological adequacy in ultrasound-guided fine-needle aspiration of solid or predominantly solid thyroid nodules. The cytological adequacy of one-needle pass is comparable to those of two and three-needle passes.

[Development and validation of a prognostic prediction model for patients with stage â to â ¢ colon cancer incorporating high-risk pathological features].

Objective: To examine a predictive model that incorporating high risk pathological factors for the prognosis of stage Ⅰ to Ⅲ colon cancer. Methods: This study retrospectively collected clinicopathological information and survival outcomes of stage Ⅰ~Ⅲ colon cancer patients who underwent curative surgery in 7 tertiary hospitals in China from January 1, 2016 to December 31, 2017. A total of 1 650 patients were enrolled, aged (M(IQR)) 62 (18) years (range: 14 to 100). There were 963 males and 687 females. The median follow-up period was 51 months. The Cox proportional hazardous regression model was utilized to select high-risk pathological factors, establish the nomogram and scoring system. The Bootstrap resampling method was utilized for internal validation of the model, the concordance index (C-index) was used to assess discrimination and calibration curves were presented to assess model calibration. The Kaplan-Meier method was used to plot survival curves after risk grouping, and Cox regression was used to compare disease-free survival between subgroups. Results: Age (HR=1.020, 95%CI: 1.008 to 1.033, P=0.001), T stage (T3:HR=1.995,95%CI:1.062 to 3.750,P=0.032;T4:HR=4.196, 95%CI: 2.188 to 8.045, P<0.01), N stage (N1: HR=1.834, 95%CI: 1.307 to 2.574, P<0.01; N2: HR=3.970, 95%CI: 2.724 to 5.787, P<0.01) and number of lymph nodes examined (≥36: HR=0.438, 95%CI: 0.242 to 0.790, P=0.006) were independently associated with disease-free survival. The C-index of the scoring model (model 1) based on age, T stage, N stage, and dichotomous variables of the lymph nodes examined (<12 and ≥12) was 0.723, and the C-index of the scoring model (model 2) based on age, T stage, N stage, and multi-categorical variables of the lymph nodes examined (<12, 12 to <24, 24 to <36, and ≥36) was 0.726. A scoring system was established based on age, T stage, N stage, and multi-categorical variables of lymph nodes examined, the 3-year DFS of the low-risk (≤1), middle-risk (2 to 4) and high-risk (≥5) group were 96.3% (n=711), 89.0% (n=626) and 71.4% (n=313), respectively. Statistically significant difference was observed among groups (P<0.01). Conclusions: The number of lymph nodes examined was an independent prognostic factor for disease-free survival after curative surgery in patients with stage Ⅰ to Ⅲ colon cancer. Incorporating the number of lymph nodes examined as a multi-categorical variable into the T and N staging system could improve prognostic predictive validity.

[Analysis of prognosis and influencing factors of No. 253 lymph node metastasis in descending colon, sigmoid colon, and rectal cancer: a multicenter study].

Objectives: To analyze the influencing factors of No. 253 lymph node metastasis in descending colon cancer, sigmoid colon cancer, and rectal cancer, and to investigate the prognosis of No. 253 lymph node-positive patients by propensity score matching analysis. Methods: A retrospective analysis was performed on clinical data from patients with descending colon cancer, sigmoid colon cancer, rectosigmoid junction cancer, and rectal cancer who underwent surgery between January 2015 and December 2019 from the Cancer Hospital of the Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Peking Union Medical College Hospital, General Hospital of the Chinese People's Liberation Army, and Peking University Cancer Hospital. A total of 3 016 patients were included according to inclusion and exclusion criteria, comprising 1 848 males and 1 168 females, with 1 675 patients aged≥60 years and 1 341 patients aged<60 years. Clinical and pathological factors from single center data were subjected to univariate analysis to determine influencing factors of No. 253 lymph node metastasis, using a binary Logistic regression model. Based on the results of the multivariate analysis, a nomogram was constructed. External validation was performed using data from other multicenter sources, evaluating the effectiveness through the area under the receiver operating characteristic curve and the calibration curve. Using data from a single center, the No. 253 lymph node-positive group was matched with the negative group in a 1∶2 ratio (caliper value=0.05). Survival analysis was performed using the Kaplan-Meier method and Log-rank test. The Cox proportional hazards model was used to determine independent prognostic factors. Results: (1) The tumor diameter≥5 cm (OR=4.496,95%CI:1.344 to 15.035, P=0.015) T stage (T4 vs. T1: OR=11.284, 95%CI:7.122 to 15.646, P<0.01), N stage (N2 vs. N0: OR=60.554, 95%CI:7.813 to 469.055, P=0.043), tumor differentiation (moderate vs. well differentiated: OR=1.044, 95%CI:1.009 to 1.203, P=0.044; poor vs. well differentiated: OR=1.013, 95%CI:1.002 to 1.081, P=0.013), tumor location (sigmoid colon vs. descending colon: OR=9.307, 95%CI:2.236 to 38.740, P=0.002), pathological type (mucinous adenocarcinoma vs. adenocarcinoma: OR=79.923, 95%CI:15.113 to 422.654, P<0.01; signet ring cell carcinoma vs. adenocarcinoma: OR=27.309, 95%CI:4.191 to 177.944, P<0.01), and positive vascular invasion (OR=3.490, 95%CI:1.033 to 11.793, P=0.044) were independent influencing factors of No. 253 lymph node metastasis. (2) The area under the curve of the nomogram prediction model was 0.912 (95%CI: 0.869 to 0.955) for the training set and 0.921 (95%CI: 0.903 to 0.937) for the external validation set. The calibration curve demonstrated good consistency between the predicted outcomes and the actual observations. (3) After propensity score matching, the No. 253 lymph node-negative group did not reach the median overall survival time, while the positive group had a median overall survival of 20 months. The 1-, 3- and 5-year overall survival rates were 83.9%, 61.3% and 51.6% in the negative group, and 63.2%, 36.8% and 15.8% in the positive group, respectively. Multivariate Cox analysis revealed that the T4 stage (HR=3.067, 95%CI: 2.357 to 3.990, P<0.01), the N2 stage (HR=1.221, 95%CI: 0.979 to 1.523, P=0.043), and No. 253 lymph node positivity (HR=2.902, 95%CI:1.987 to 4.237, P<0.01) were independent adverse prognostic factors. Conclusions: Tumor diameter ≥5 cm, T4 stage, N2 stage, tumor location in the sigmoid colon, adverse pathological type, poor differentiation, and vascular invasion are influencing factors of No. 253 lymph node metastasis. No. 253 lymph node positivity indicates a poorer prognosis. Therefore, strict dissection for No. 253 lymph node should be performed for colorectal cancer patients with these high-risk factors.

Preliminary clinical observations on autologous cultured skin fibroblasts transplantation in the treatment of keloids: a case report.

BACKGROUND: Keloids are benign skin lesions that gradually invade the surrounding normal tissue, and no treatment has proven curative. In our previous clinical practice of autologous cultured fibroblast transplantation, we found that fibroblast injection might have some effect on treating keloids, and we attempted to treat keloids by using fibroblast transplantation after obtaining the patient's approval. CASE REPORT: 1 patient was treated from March 2017 to June 2018. Autologous skin fibroblasts were separated from postauricular skin biopsy or resected keloid. They were cultured and expanded with exclusive methods. Cells (3×107/ml) within four or five passages were injected intradermally at the keloid at one-month intervals, 15 times in the patient. Shrink of the keloid on the patient was observed. The keloid became softer, flatter, and lighter in color after treatment. The elasticity of the keloid was also increased. The treatment effect was associated with the number of treatment sessions. CONCLUSIONS: This is the first report in which autologous fibroblast transplantation was used to treat keloids. Despite being only a single case experience, it suggests that keloid formation is a complex process in which still unknown factors may play a role.

[Evaluation of quality of life in patients with Graves orbitopathy and its influencing factors].

Objective: To evaluate life quality of Graves orbitopathy (GO) patients using Graves orbitopathy quality-of-life questionnaire (GO-QOL) and explore the influence factors of the quality of life of GO patients. Methods: This was a cross-sectional study conducted at The Third Affiliated Hospital of Southern Medical University including 145 newly diagnosed GO patients. All the patient answered the GO-QOL and underwent ophthalmic and endocrine assessments. The main outcome measures were the scores on GO-QOL 2 subscales: visual functioning and appearance. Based on the classification in the guideline of European Group on Graves Orbitopathy (EUGOGO), the patients were divided into two groups: mild and moderate to severe groups. Then the scales between these two groups were compared and influencing factors were analyzed. Finally, the floor and ceiling effects were assessed. Results: The GO-QOL scores for the subscales of visual functioning and appearance were 70.91±27.83 and 61.29±26.37 respectively in 145 GO patients. Visual functioning and appearance were lower in moderate to severe group (62.71±28.77 and 57.52±26.49, respectively) than in mild group (85.58±18.77 and 68.02±24.99, respectively).The GO-QOL scores for the visual functioning subscale were significantly correlated with age (P=0.002), clinical active score (P=0.011) and the degree of diplopia (P=0.00, R(2)=0.373). The GO-QOL scores for the appearance were significantly correlated with sex (P=0.05) and thyroid-stimulating hormone levels (P=0.001, R(2)=0.231). No significant ceiling or floor effects were observed for either subscale of the GO-QOL. Conclusions: With the aggravation of the disease, the quality of life of GO patients is getting worse and worse. The main influencing factors of the quality of life of GO patients include age, gender, diplopia, clinical active score and thyroid-stimulating hormone levels. Close attention needs to be paid to the quality of life of GO patients.

The effects of a sodium-glucose cotransporter 2 inhibitor on diabetic nephropathy and serum oxidized low-density lipoprotein levels.

OBJECTIVE: To investigate the effect of an SGLT-2 inhibitor on diabetic nephropathy and serum oxidized low-density lipoprotein (ox-LDL) levels. PATIENTS AND METHODS: We randomly divided 126 patients with diabetic nephropathy into the treatment group and control group. The 63 patients in the treatment group received an SGLT-2 inhibitor in addition to routine insulin therapy, while the control group received only insulin to control blood glucose. All laboratory indexes were recorded before and after treatment with the SGLT-2 inhibitor. The prognosis of patients was followed-up. Simultaneously, 63 healthy and BMI-matched in-patients were selected as the healthy control group. Peripheral blood samples were collected from all groups, and the levels of ROS were measured by ELISA. RESULTS: Renal function indexes such as urinary protein, creatinine, blood urea nitrogen, and glomerular filtration rate (GFR) were significantly higher with SGLT-2 inhibitor treatment compared with the control group (p<0.05). The fasting blood glucose level was not significantly increased before or after treatment (p>0.05). The levels of ROS in peripheral blood were significantly lower in the treatment group than in the control group (p<0.05). Observation at the 1-year follow-up showed that the average GFR was significantly higher in the treatment group than in the control group. Furthermore, the proportion of patients with stage 1-3 chronic kidney disease was significantly higher in the treatment group than in the control group (p<0.05). CONCLUSIONS: The SGLT-2 inhibitor had a good therapeutic effect on renal function in patients with diabetic nephropathy, without having effects on fasting blood glucose. Additionally, it significantly delayed the progression of nephropathy. It is therefore worth clinical promotion.

[Diagnostic value of combination of US and MRI in preoperative prediction for the extrathyroidal extension of papillary thyroid carcinoma].

Objective: The purpose of the present study was to evaluate the diagnostic performance of preoperative ultrasonography(US), magnetic resonance imaging(MRI) and US combined with MRI in the prediction of extrathyroidal extension(ETE) in patients with papillary thyroid carcinoma(PTC). Methods: Between January 2013 and December 2016, a total of 83 consecutive patients underwent surgery for pathologically confirmed PTCs with ETE. We analyzed all patients with PTC with ETE who received preoperative combination of US and MRI scan to evaluate ETE. Results: For minimal ETE, the accuracy was 92.2%(47/51) of US, 74.5%(38/51) of MRI, and their combination was 98.0%(50/51). The differences of the three methods for minimal ETE were statistically significantly different(P=0.000). For extensive ETE, the accuracy was 62.5%(20/32) of US, 87.5%(28/32) of MRI, and their combination was 93.8%(30/32). The different of the three methods for extensive ETE was statistically significantly different(P=0.000). For the total accuracy of ETE, US was 80.7%(67/83), MRI was 79.5% (66/83), and their combination was 96.4%(80/83). The difference of the three methods for ETE was statistically significantly different(P=0.001). Conclusion: The combination of US and MRI can improve the preoperative diagnostic accuracy of ETE for PTC.